Swiss medical weekly
-
Swiss medical weekly · Nov 1990
[Methods in mixed ventilation: advantages, disadvantages and consequences for work of breathing].
During partial ventilatory support modes both the ventilator and the patient are performing mechanical work. These modes are currently used as mechanical ventilatory support to provide a better synchronism between the patient and the machine and to avoid a complete rest of the respiratory muscles, or as modes of weaning from mechanical ventilation. ⋯ Lastly, during inspiratory pressure support, each spontaneous cycle is assisted by pressurization of the circuit. This latter modality alone seems efficiently to decrease the patients' breathing work while allowing complete synchronism between patient and ventilator.
-
Swiss medical weekly · Oct 1990
Recent advances in myocardial protection using antegrade/retrograde blood cardioplegia.
This presentation details techniques of delivery of antegrade/retrograde blood cardioplegia to ensure its distribution to prevent ischemic damage during aortic clamping, and describes methods of using warm blood cardioplegia to "resuscitate" the heart when used to induce cardioplegia and "avoid reperfusion damage" when given just before aortic unclamping. A technique of rapid transatrial cannulation of the coronary sinus is described to permit safe, rapid, and simple use of retrograde cardioplegia and avoid right heart isolation. Theoretic objectives of these operative techniques are discussed, together with presentation of the specific methods of achieving the aforementioned goals of using blood cardioplegia for resuscitation, prevention, and avoidance of ischemic and reperfusion damage. The preliminary clinical experience with antegrade/retrograde cardioplegia is summarized, and these results have led to adoption of these techniques of blood cardioplegia as the preferred method of myocardial protection in all adult operations and in many pediatric cardiac procedures.
-
Swiss medical weekly · Sep 1990
[Prognostic value of electroencephalography in non-traumatic comas].
We recorded an EEG within the first few days of coma in 100 patients without history of trauma or drug intoxication, in 50 after cardiac arrest, and in 50 in coma of other, chiefly metabolic etiologies. The EEG findings were classified in 5 categories (I-V) in terms of increasing severity. We were especially interested in the question whether the degree of early EEG disturbances allows prognostic conclusions regarding the clinical fate of patients one month after the beginning of coma. ⋯ The prognostic significance of certain EEG parameters can be summarized as follows: areactivity to external stimuli and the presence of an "alpha-coma" pattern are usually (but not necessarily) associated with a poor outcome. The same applies to coma patients with epileptiform patterns in the EEG and/or suffering from epileptic or myoclonic seizures. One-fourth of patients with triphasic EEG complexes recover completely.
-
Swiss medical weekly · Aug 1990
Case Reports[Isolated trochlear nerve paralysis following head trauma].
39 cases with isolated trochlear nerve palsies of traumatic origin have been analyzed retrospectively. 18 patients (46%) had had cerebral contusion, 15 (39%) cerebral concussion, and 6 patients (15%) a minor head trauma. 33 patients had unilateral trochlear nerve palsies and 6 (all of them with cerebral contusion) bilateral. The degree of the palsies did not correlate with the severity of the head trauma. ⋯ This was the case in 21 of our 39 patients (54%). Simple clinical examination techniques are described (Bielschowsky phenomenon, pencil test), which allow detection of trochlear nerve palsies in most cases.